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Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Now that they’ve gotten an EMR in shape to collect Meaningful Use payouts, hospitals are examining what those incentive bucks have gotten them. And apparently, many aren’t happy with what they see. In fact, it looks like a substantial number of hospitals are ripping and replacing existing EMRs with yet another massive system.

But if they thought that the latest forklift upgrade would be the charm, many were wrong. A new study by Black Book Research suggests that in the frenzy to replace their current EMR, many hospitals aren’t getting what they thought they were getting. In fact, things seem to be going horribly wrong.

Black Book recently surveyed 1,204 hospital executives and 2,133 user-level IT staffers that had been through at least one large EMR system switch to see if they were happy with the outcome. The results suggest that many of these system switches have been quite a disappointment.

According to researchers, hospitals doing new EMR implementations have encountered a host of troubles, including higher-than-expected costs, layoffs, declining inpatient revenues and frustrated clinicians. In fact, hospitals went in to these upgrades knowing that they would not be back to their pre-EMR implementation patient volumes for at least another five years, but in some cases it seems that they haven’t even been keeping up with that pace.

Fourteen percent of all hospitals that replaced their original EMR since 2011 were losing inpatient revenue at a pace that would not support the total cost of the replacement EMR, Black Book found. And 87% of financially threatened hospitals now regret the executive decision to change systems.

Some metrics differed significantly depending on whether the respondent was an executive or a staff member.

For example, 62% of non-managerial IT staffers reported that there was a significantly negative impact on healthcare delivery directly attributable to an EMR replacement initiative. And 90% of nurses said that the EMR process changes diminished their ability to deliver hands-on care at the same effectiveness level. In a striking contrast, only 5% of hospital leaders felt the impacted care negatively.

Other concerns resonated more with executives and staff-level respondents. Take job security. While 63% of executive-level respondents noted that they, or their peers, felt that their employment was in jeopardy to the EMR replacement process, only 19% of respondents said EMR switches resulted in intermittent or permanent staff layoffs.

Meanwhile, there seemed to be broad agreement regarding interoperability problems. Sixty-six percent of system users told Black Book that interoperability and patient data exchange functions got worse after EMR replacements.

What’s more, hospital leaders often haven’t succeeded in buying the loyalty of clinicians by going with a fashionable vendor. According to Black Book, 78% of nonphysician executives surveyed admitted that they were disappointed by the level of clinician buy-in after the replacement EMR was launched. In fact, 88% of hospitals with replacement EMRs weren’t aware of gaining any competitive advantage in attracting doctors with their new system.

Now, we all know that once a tactic such as EMR replacement reaches a tipping point, it gains momentum of its own. So even if they read this story, my guess is that hospital executives planning an EMR switch will assume their rollout will beat the odds. But if it doesn’t, they can’t say they weren’t warned!

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In most industries, prices fall as supply rises. Basic economics, right? Well, if that’s true, will the price of EMRs fall as the industry matures? A recent discussion on LinkedIn demonstrates – as you might expect – that there’s a lot of room for debate on the topic.

Davíð Þórisson, an emergency physician at Landspitali University Hospital in Iceland, kicked things off with this question:

Now that the major workflow has been designed in all major EHR systems available it would seem the biggest part of the hospital needs are addressed. Competition should increase as more vendors catch on… prices surely must go down from here?

Nelson Wong, a senior consultant with Fuji Xerox, responded that price increases are all but inevitable when EMR vendors compete with proprietary technology:

The only way out is a vendor neutral EHR providers to integrate all systems with international standard like HL7.

Zac Whitewood-Moores, a clinical data standards specialist who’s helping to implement SNOMED CT in systems across the NHS in England, noted that EMR vendors currently have little incentive to switch to a cheaper, less-customized EMR model:

Vendors appear reluctant to share work from previous deployments and part of this has to be that the commercial model is built on consultancy, not just licensing of the IT product itself.

But Whitewood-Moores also holds out hope that true data interoperability could do the trick:

When there is more use of SNOMED CT and common interoperability models forced by purchasing goverments/health providers…this may bring down costs if customers are not locked in by their data and the costs of migrating large amounts of it.

I think the key with EHRs is to ensure the industry continues to innovate on how information is captured. Perhaps secure automation will drive down this cost as we learn ways to transfer health data from medical grade wearables?

On the other hand, other people who commented felt that even some kind of open source reference EMR wouldn’t do the trick. John Shepard, president and co-founder of HIT software vendor Shepard Health, points out that there’s actually surprisingly little pressure on vendors to lower prices, in part because the market is still evolving:

The cost of EHRs has already gone down but also up. For example, you can buy an EHR out of the box at Costco or utilize one of the open source EHRs for free. However, to get a supported enterprise-level EHR (Epic, McKesson, etc.) then the price is very high and I don’t think it will come down anytime soon…[After all,] the cost of the EHR is not preventing sales because there is minimal change in demand based on increase in cost.

Meanwhile Pim Volkert, terminologies coordinator for Nicitz, the National IT Institute for Healthcare in the Netherlands, shared an interesting view of the future. He seems to suggest that paying more for EMRs may actually be justified as they grow more sophisticated:

EHRswill move more and more into the clinical domains. [They] will become a medical device just like an MRI or DaVinci robot. Development, testing of software and liability insurance fees will increase costs.

Obviously, there’s no way to predict exactly where EMR prices will go, but I’m more on the side of the posters suggesting that enterprise EMRs have nowhere to go but up. I hope I’m wrong!

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

After several years of EMR deployment, one would think that the EMR value proposition had been pretty well established. But the truth is, the financial and clinical return on EMRs still seems to be in question, at least where some aspects of their functioning are concerned.

That, at least, is what I took from the recent HIMSS “Value of Health IT Survey” released earlier this month. After all, you don’t see Ford releasing a “Value of Cars Survey,” because the value of a car has been pretty much understood since the first ones rolled off of the assembly line more than a century ago.

Industry-wide, the evidence for the value of EMRs is still mixed. At minimum, the value proposition for EMRs is a remarkably tough case to make considering how many billions have been spent on buying, implementing and maintaining them. It’s little surprise that in a recent survey of CHIME members, 71% of respondents said that their top priority for the next 12 months was to realize more value from their EMR investment. That certainly implies that they’re not happy with their EMR’s value prop as it exists.

So, on to the HIMSS survey. To do the research, HIMSS reached out to 52 executives, drawn exclusively from either HIMSS Analytics EMRAM Stage 6 or 7, or Davies Award winning hospitals. In other words, these respondents represent the creme de la creme of EMR implementors, at least as HIMSS measures such things.

HIMSS researchers measured HIT value perceptions among this elite group by sorting responses into one of five areas: Satisfaction, Treatment/Clinical, Electronic Information/Data, Patient Engagement and Population Management and Savings.

HIMSS’ topline conclusion — its success metric, if you will — is that 88 percent of execs reported at least one positive outcome from their EMR. The biggest area of success was in the Treatment/Clinical area, with quality performance of the clinical staff being cited by 83% of respondents. Another area that scored high was savings, with 81% reporting that they’d seen some benefits, primarily in coding accuracy, days in accounts receivable and transcription costs.

On the other end of the scale, execs had to admit that few of their clinical staffers are satisfied with their EMRs. Only 29% of execs said that their EMR had increased physician satisfaction, and less than half (44%) said their nurses were more satisfied. If that isn’t a red flag I don’t know what is.

Admittedly, there are positive results here, but you have to consider the broader context for this study. We’re talking about a piece of software that cost organizations tens or even hundreds of millions of dollars, upon which many of their current and future plans rest. If I told you that my new car’s engine worked and the wheels turned, but that the brakes were dodgy, fuel economy abysmal and the suspension bumpy, wouldn’t you wonder whether I should have bought it in the first place?

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s too early to make a definitive claim, but I’m picking up some increasing evidence that Cerner is beginning to win out over Epic as some health systems upgrade. I’m not suggesting that Epic is ready to topple by any means, but it does seem that Cerner’s winning more potential matchups than they were before.

Want an example? Take the recent news that Iasis Healthcare will switch out its McKesson platform for the Cerner Millenium EMR. The 17-hospital system will spend $50 million to make the upgrade, which should be complete by March 2018. Most of the spending is ($35M+) is projected to come in fiscal 2016.

As I noted in an earlier post, Epic continues to grow at, well, an Epic pace. Reports suggest that Epic added 1,400 staffers last year, and the company seems likely to keep on pace in 2016. And as I previously noted, Epic software is either being used by or installed at 360 healthcare organizations in 10 countries, and also reported generating $1.8 billion in revenues for 2014.

But as the Iasis deal illustrates, Cerner is picking up some split-decision deals for what look like important reasons. One intriguing reddit post by captainnoob explains why his health system went with Cerner:

We whittled our choice down to 3 applications… McKesson Paragon, Epic, and Cerner. Those 3 were our forerunners as they were fully integrated and had modules to handle (almost) every service our facility provides. Ultimately the decision to go Cerner was based primarily on a combination of user input and cost of ownership.

User Input – We did numerous site visits with users from various clinical and managerial areas to talk workflow, ask questions such as how each product dealt with certain challenges we have already faced with McKesson, and view demonstrations in real-world conditions.

Cost of Ownership – Not just the cost of the product and implementation, but the cost of maintaining the product over 5-10 years.

I’m not sure why the competitive advantages Cerner has have shown up in higher relief recently. But my guess is that the wins Cerner is capturing have something to do with the psychology of EMR investment.

Going from a severely underpowered system — or none — to Epic involves taking a big leap of faith. How can you rationalize spending dozens or even hundreds of millions (or billions) on Epic? I’d argue that in essence, the ROI on that buy has been essentially unguessable. So the systems that have made a big Epic buy have had to justify their investment by pointing to big, still-intangible benefits like improved population health.

On the other hand, health systems that didn’t do Epic the first time, and have reasonably competent systems on board already, aren’t buying vision or reputation-ware. They aren’t pioneers, but instead, are looking for an economically and technically workable solution. In that circumstance, I know I’d be far more likely to go with a system with a lower total cost of ownership than an expensive Big Blue-style tool.

But these are just my theories. What do you think? Is the investment tide turning toward Cerner, and why?

David is a global digital healthcare leader that is focusing on the next era of healthcare IT. Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

The top news last week was from Quality Systems Inc., which owns physician software vendor NextGen Healthcare Information Systems. The news was that NextGen will acquire HealthFusion Holdings, another ambulatory vendor, for $165 million (NextGen also sold their hospital division to QuadraMed the week before). As healthcare systems are consolidating, we are also seeing the consolidation happen on the vendor side and the payer side. The shrinking healthcare profit margin has an effect on the entire industry.

What is next for the ambulatory space?

Physician Groups Joining Health Systems

As we move towards creating a clinical integrated network, the number of physician groups and independent physicians will also decrease where the majority will join an ACO or become an employee for the health systems. The decrease in medical groups and the consolidation of the medical groups will have a huge impact on the ambulatory EMR space. The industry will see a shift in the ambulatory EMR systems transition to the same EMR system that is used by the health systems, so I see a big pickup for the Cerner and Epic in the ambulatory world.

Enterprise EMR

The enterprise EMR will have bigger demands from their clients to focus on the ambulatory side. Health systems are utilizing their technology investments as part of the outreach and growth strategy so it is vital that the clinics and medical groups have a system that fits their workflow. Many industry leading healthcare organizations are becoming a software EMR vendor by providing their ambulatory system to smaller hospitals, rural clinics, and physician groups that cannot afford the technology investment of an enterprise system.

This will be a very interesting space to watch in the next year. We’ll see which players will survive and see what their strategies will be moving forward. I have been providing advisory services for many health systems in regards to their strategy for maximizing their technology investment and making it a revenue-generating tool. So I will be keeping a close eye on this space and sharing insights with you on CXO Scene going forward.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I say intriguing not because the formula outlined will surprise anyone, but rather, because it captures some very difficult problems in a concise and impactful manner.

Here’s some thoughts on the issues Portnoy raises:

* Optimization: Of course, every healthcare IT organization works to optimize every technology it deploys. But doing so with EMRs is one of the most difficult problems it is likely to encounter. Not only do IT leaders need to optimize the EMR platform technically, they may also face external demands placed by ACOs, HIE partners and affiliated providers. And it’s also important to optimize for Meaningful Use functions.

* Workflows: Building workflows that address the needs of various stakeholders is critical, as pre-designed vendor workflow options may be far from adequate. While implementing an EMR may be an opportunity for a hospital to redesign workflows, or to enshrine existing workflows in the EMR interface and logic, hospital leaders need to take charge of the workflow implementation process. Inefficiencies at this level can be costly and will erode the confidence of clinical teams.

* Revenue capture: When properly implemented, EMRs can help providers generate more complete documentation for claims reimbursement, which leads to higher collections volume. As time has shown, difficult-to-use EMRs can lead to physician frustration, and in turn, cut-and-paste re-use of existing documentation — which is why carefully-designed workflow is so important. But if they are used appropriately, EMRs can boost revenue painlessly.

* Patient and provider engagement: True, IT needs to take the lead on getting the EMR in place, and must make some important deployment decisions on its own. Still, hospitals will have trouble meeting their goals if patients and providers aren’t invested in its success, and without patient interest in their data I’d argue that meeting long-term population health goals is unlikely. On the flip side, if clinicians and patients are engaged, the feedback they offer can help hospitals shape not only the future of their EMR, but also the rest of their clinical data infrastructure.

If there’s any common theme to all of this, I’d submit, it’s participation. Unlike most efforts corporate IT departments undertake, EMR rollouts are unlikely to work until everyone they touch gets on board. Hospitals can invest in any EMR technology they like, but if providers can’t use the system comfortably to document care, patients don’t log on to access their data, or revenue cycle managers don’t see how it can improve revenue capture, the project is unlikely to offer much ROI.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I was reading a piece in Healthcare Finance News concluding that now more than ever, hospitals are being judged by financial analysts by the number of days’ cash they had on hand. At the same time, the story noted that hospitals are facing some of the biggest financial stresses they’ve faced in decades, with high patient deductibles and copays leading to drops in collections, switches to risk-based compensation cutting margins and the ever-present need for EMR and other IT investment looming.

When you boil all of this down to the essentials, you’ve got a pitched battle going between the need for current liquidity and the need for future liquidity. While having cash on hand shored up for a rainy day makes analysts like Moody’s happy, failing to spend on the right IT infrastructure undercuts the chances of making it work a few years in the future.

After all, if you don’t have a current revenue cycle management system in place, payments can slip through your hands that could have been collected. Without spending the right amount in (on the right product, at least) on tools that help manage risk-based contracts, health systems and ACOs can end up losing big money on these contracts.

And even hospitals that aren’t in robust shape are betting their financial future on big EMR investments because they clearly consider it necessary to do so. For example, as I noted in a post earlier this year, Chattanooga, TN-based Erlanger Health System just committed to a 10-year, $100 million deal to put Epic in place despite its only recently having recovered from serious financial challenges.

So the question becomes whether hospitals can risk being cash-poor for now — at least by one measure — in an effort to keep the IT tools they need at hand. Obviously, there’s no one-size-fits-all answer, but industry strategies seem to offer a hint.

The reality seems to be that many health systems and hospitals feel they need to invest in IT upgrades and new technologies whether the traditional metrics fall into line or not. As scary as the regulatory issues (such as the ICD-10 upgrade) and changes in compensation are, health organizations like Erlanger are making the bet that even if it makes them uncomfortable now, having the right IT in place is a must-do.

While I’m no financial genius, my guess is that this means hospitals are going to voluntarily let key metrics like DCOH slip in favor of building for a solid future. I suppose we’ll know in five years or so whether taking such a risk pushed a bunch of hospitals over the cliff.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This weekend, feeling a bit too ill to wait to see my PCP, I took myself to a community hospital in my neighborhood. For various reasons, I went to a hospital I don’t usually visit, one about 10 miles away from my home.

When I entered the emergency department lobby, nothing seemed amiss.

In fact, the light-filled, pleasantly-constructed waiting room was comfortable and modern, the staff seemed bright and knowledegeable, and the triage nurse saw me promptly.

But I got something of a surprise when I checked in with the triage nurse during my initial assessment. Noting that she had not taken my medication history, I told the nurse that I assumed someone would be entering it into their EMR later.

“We don’t have an EMR,” said the kind and sympathetic triage nurse apologetically. “Everything is still on paper. We might have an EMR in a year or so, but we’re not even sure about that.”

As it later turned out, she was mistaken. The hospital did indeed have an EMR in place, one by MEDITECH, but had put all new upgrades on hold, leaving the clinical staff to do almost all documentation on paper. Regardless, the staff didn’t have access to the higher capabilities of an EMR, and that’s the message that the triage nurse had gotten. (And no one ever did take my list of medications.)

Now, it’s not necessarily the case that this hospital had no grasp of its data. In fact, to my surprise, the front desk was able to tell me that I had been seen there in 2002, something of which I had no memory.

But it’s hard to imagine that the very long wait I endured, which took place in the attractive lobby of a quiet, prosperous suburban hospital, was not due in part to the hospital’s lack of automation. It should be noted that within the next several months to a year, the chain to which the hospital belonged expects to bring the hospital I visited onto its Epic platform. But again, the staff was stumbling around in the dark, comparatively speaking, the day I visited the ED.

Now, hospitals survived on paper documentation for many years, and there’s no reason to think this one won’t survive for a year or so using paper charts. What’s more, it may very well be that the real problem this hospital faced had to do with patient mix and staffing concerns. I did note that many of the patients coming in seemed to be seeking weekend primary care, for which the hospital may not have been as prepared as it should have been.

That being said, an EMR is not just a clinical tool. Put coldly, it’s an instrument of industrial automation which can keep patients moving through the assessment and discharge process more quickly and effectively.

I’m not saying the facility needs to have a fully-launched marquee EMR just to impress patients like myself. In fact, postponing expanding the Epic EMR for a while may be a great financial decision, and from an IT standpoint, better to roll the Epic system out at a sustainable pace than throw it at an unprepared workforce.

But watching nurses and doctors record details on endless sheets of paper, and struggle to track down paper charts for acutely ill patients, was a harsh reminder of what the industry has left behind.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The seemingly eternal struggle between EMR giants Cerner and Epic Systems has ended in another win for Epic, which was the final choice of Chattanooga, TN-based Erlanger Health System. The health system’s CEO, Kevin Spiegel, who said that Cerner had been its other finalist, announced last week that Erlanger would spend about $100 million over 10 years for the Epic installation.

Erlanger, a four-facility public hospital system with about 800 total beds, is an academic medical system and serves as a campus of the University of Tennessee College of Medicine. The system also partners with UT to operate the UT Erlanger Physicians Group, a 170-member multispecialty practice.

The health system, which fell in financial trouble in 2012, only recently saved itself and positioned itself for the massive Epic investment. It closed out FY 2014 with $618M in total operating revenue and $18M in operating income.

Erlanger’s turnaround is all well and good. But that being said, these numbers suggest that Erlanger is making something of a gamble by agreeing to an approximately $10M a year health IT investment. After all, the health system itself concedes that its return to financial health came in large part due to $20 million in new Medicare and Medicaid funding from CMS, along with new funding from the state’s Public Hospital Supplemental Payment Pool. And politically-obtained funds can disappear with the stroke of a pen.

The risky nature of Erlanger’s investment seems even more apparent when you consider that the system has an aggressive building plan in place, including a new orthopedic center, a $68M expansion of one of its hospitals, a 100,00 square foot children’s & women’s ambulatory center and a new health sciences center. Particularly given that Erlanger just completed its turnaround last year, does it make sense to squeeze in Epic payments alongside of such a large capital investment in infrastructure?

What’s more, the health system has a bond rating to rehabilitate. Faced with financial hardships in 2013, its bond rating was downgraded by Moody’s to a Baa2 and the system’s outlook was rated “negative.” By 2014, Erlanger’s had managed to boost the Moody’s outlook to “stable,” in part due to the influx of state and federal funds obtained by Erlanger execs, but the Baa2 rating on its $148.4 million in bond debt stayed in place.

While I imagine the hospital will realize a return on its Epic spending at some point, it’s hard to see it happening quickly. In fact, I’d guess that it’ll be years before Erlanger’s Epic install will be mature enough to be evaluated for ROI, given the level of effort it takes to build a mature install.

In the meantime, Erlanger leaders may be left wondering, from time to time at least, whether they really can afford their expensive new EMR.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I first met with Stoltenberg Consulting a few years back at CHIME, they said something really interesting that I’m still thinking about today. In fact, I might be thinking about this more today than I was doing before.

Per my notes (so I won’t make it a direct quote), they commented that doctors were putting a lot into the EHR, but they don’t feel like they’re getting a lot out of the EHR.

It’s a powerful idea that is really important for any hospital executive to understand.

The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Choice of EHR is only one of the main reasons why doctors likely feel that they’re getting less out of the EHR than they’re putting into it. Certainly reimbursement requirements and meaningful use should still take a lot of the blame as well. Regardless of how we got here, it’s a very precarious position when the doctors feel like they’re getting less out of the EHR than they are putting into it.

There is a solution to this problem. First, you must work to maximize the physician workflow. Sometimes this means involving the nursing staff more. Sometimes this involves a scribe. Other times it requires a change to your EHR. Other times it means building out high quality templates that make the doctor more efficient.

Second, we must all focus on more ways doctors can get more value out of their EHR. The buzzword analytics has potential, but has been a little too much buzz word and not enough practical improvement for the doctor and patient. We need more advanced tools that leverage all the data a doctor’s putting in the EHR. Clinical Decision Support, Drug to Drug and Drug to Allergy checking are just the first steps. We can do so much more, but unfortunately we’ve been too distracted by government regulation to deal with them. Plus, let’s not kid around. These aren’t easy problems to solve. They take time and effort. Plus, we need a better way for doctors and hospitals to be able to diffuse their discoveries across the entire healthcare community. Sharing these discoveries is just too hard and too slow right now.
At the end of the day, it’s a simple scale. On the one side you have the time and effort a doctor puts into the EHR. On the other side is the value the doctor gets from the EHR. You can solve this by making the doctor’s EHR work more efficient or by finding more ways the EHR can provide value to the doctor. Much easier said than done. However, if this stays out of balance too long, you can count on a big EHR backlash from doctors.